Medication 7-088 - Ancef (Cefazolin)

CMH EMS & MIH Protocols

Scope of Practice:

• Registered Nurse
• Paramedic
• Community Paramedic

Route(s):

• IO, IV,

Pharmacodynamics (class and mechanism of action):

• Antibiotic.
• Cephalosporin (1st Generation).
• Inhibits bacterial cell wall synthesis.

Pharmacokinetics:

• Half-life: 1.8 -2 hours (prolonged with renal impairment).
• Peak action time: 5 minutes (IV/IO).

Dosing:

• Pediatrics 35mg/kg (max 2 g) over 5min.
• Adults < 120kg 2gm IVP over 5min, OR 10min infusion in 100ml NS.
• Adults >120kg 3gm IVP over 5 min, OR 10min infusion in 100ml NS

Preparation Instructions:

• Each 1 gram of Ancef comes in a powder vial that must be reconstituted.
• Reconstitute each 1gm vial with 2.5mL NS. Gently shake, or swirl the vial to mix the powder and NS until all particulates are dissolved, approximately 30 seconds to one minute. DO NOT VIGROUSLY SHAKE THE VIAL or medication may foam.
• This will result in a final Ancef concentration of 330 mg/mL
• For pediatric patients weighing 28 kg or less:
  • Explanation: Calculate the appropriate volume of Ancef needed (weight in KG X 35mg/kg) this will result in the total mg needed for the patient. To find the volume needed to withdraw from the vial divide the desired dose you now have in milligrams with the concentration of the reconstituted vial of 330mg/ml. This will give you the volume you need to withdraw from the vial. Using a 5ml syringe, remove the appropriate weight based dose. Add enough NS to the Ancef syringe to bring it to a full 5mLs. This will be administered over 5 minutes with a push rate of 1mL/minute.
  • Formula: (kg x 35mg/kg) = desired dose/(330mg/ml)= ml to draw from vial + NS to total 5ml
• For pediatric patients weighing 29 kg or more and all adults < 120kg:
  • Explanation: You will need two 1gm vials of Ancef. Calculate the appropriate volume of Ancef needed (weight in KG x 35mg/kg) this will give you the milligrams to be administered. Max dose for children and adults under 120kg is 2,000mg. Reconstitute each vial as above, and utilize a 10ml syringe to remove the appropriate volume of Ancef. Add enough NS to the Ancef syringe to bring it to a full 10mLs. This will be administered over 5 minutes with a push rate of 2mL/minute
  • Formula: (kg X 35mg/kg) = desired dose/(330mg/ml)= ml to draw from vial + NS to total 10ml

  • Ancef Pediatric Quick Reference Sheet
    AGE	KG	MG DOSE	ML DRAWN
    Premie	2	70	0.2
    Newborn	4	140	0.4
    4 mo	6	210	0.6
    6 mo	8	280	0.8
    1	10	350	1.1
    2	12	420	1.3
    3	15	525	1.6
    4	17	595	1.8
    5	20	700	2.1
    6	22	770	2.3
    7	25	875	2.7
    8	27	945	2.9
    9	30	1050	3.2
    10	35	1225	3.7
    11	40	1400	4.2
    12	50	1750	5.3
    13	60	2000	6
    Additional Comments
    Ancef vial concentration: 330 mg/mL
    Weighty Matters:  A Real-World Comparison of the Handtevy and Broselow Methods of Prehospital Weight Estimation (2022, file attached in email)

• For patient’s weighing >120kg, you will need three 1gm vials of Ancef. Reconstitute each vial as above, and utilize a 10ml syringe to remove the appropriate volume of Ancef (9.1mL). Add enough NS to the Ancef syringe to bring it to a full 10mLs. This will be administered over 5 minutes with a push rate of 2mL/minute.

Alternative Bolus Administration

• For adults weighing less than 120kg
  • add 2 grams of Ancef into a 100ml bag of NS and administer over 10 minutes.
• For adults weighing over 120kg
  • add 3 grams of Ancef into a 100ml bag of NS and administer over 10 minutes

Indications:

• Open fracture.
• 2-396 - Extremity Trauma
• 2-451 - General Trauma Management

Contraindications:

• Allergy to caefazolin or other cephalosporin antibiotics.

Pregnancy Risk Factor:

• Category B
• No risk in other studies: Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women, or animal studies have shown adverse effects, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester.

Potential Incompatibilities:

• Do not mix with other medications. Compatible with all IV solutions.

Antidote:

• N/A.

Controlled Substance Information:

• Not a scheduled drug
• The DEA and FDA have not identified this drug with a schedule classification.
• DEA number: NA.
• Narcotic: No.
• Street names: NA.

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Polk, Hickory, Cedar, & St Clair County EMS Protocols is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.